title: Long-term outcomes of a dynamic ankle-foot orthosis on gait characteristics of a service member with incomplete nerve injury to the lower extremity: a case report.
abstract: This case study reports a 5-year follow-up of a 32-year-old male service member who suffered polytrauma in 2007 following a Humvee rollover in Afghanistan. The service member's injured left lower extremity was salvaged, but severe damage to the lumbosacral plexus and significant injuries to the pelvis, hip, and femur resulted in near total paralysis and foot drop of the left lower limb. Two years of multiple substandard ankle-foot orthotic devices pushed him to investigate a dynamic ankle-foot orthotic (DAFO) with energy storing capability, which allowed him to remain on active duty and deploy for a second tour while wearing the device. The anecdotal improvements described by this service member prompted a biomechanical analysis of walking and running gait, comparing a shoes only condition to the DAFO. Results of gait analysis demonstrated an improvement in spatial-temporal parameters in both walking and running, improved sagittal angles and moments at the ankle, knee, and hip, greater ankle stability through decreased dorsiflexion excursion, and a marked increase in ankle power while running. Most notably, the service member credits this device for substantial improvement in quality of life including total cessation of pain medication and return to regular vigorous activity.
authors.affiliation: University of Hawai'i Mañoa, 1337 Lower Campus Road PE/A 231, Honolulu, HI 96822, USA.
authors.forename: Melanie M
authors.initials: MM
authors.lastname: Presuto
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Stickley
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Perlsweig
authors.forename: Iris F
authors.initials: IF
authors.lastname: Kimura
authors.forename: Gerard M
authors.initials: GM
authors.lastname: Antoine
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D061826:Foot Orthoses; D005684:Gait / Q000502:physiology*; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007866:Leg / Q000294:innervation; D008297:Male; D008889:Military Personnel; D059348:Peripheral Nerve Injuries / Q000150:complications*; D012420:Running / Q000502:physiology; D014481:United States; D016138:Walking / Q000502:physiology